The use of anabolic steroids and associated drugs (such as human growth hormone) has been associated with diverse adverse effects on both physical and psychological health, including, on rare occasions’ fatalities. However, this issue remains poorly researched, with evidence predominantly being drawn from case studies/reports and self-reported effects from the users themselves. Many of the adverse effects to anabolic steroids may be classed as dose dependent, with higher dosages being more likely to result in both short and long term adverse effects. The length of time the drugs are used for can also influence the likelihood of adverse effects, with longer regimes possibly more likely to produce side-effects. Another key factor in relation to the adverse effects of anabolic steroid use is the underlying health of the drug user. Specific individuals will have a much higher genetic propensity to some adverse effects. These may be either the less dramatic side effects that many users will consider as being manageable, to potentially life threatening conditions affecting the cardiovascular or hepatic systems. Furthermore, responses to drugs can be idiosyncratic, characterised by an unpredictable hyper-response to a stimuli, in this case the self-directed administration of anabolic steroids.

The most commonly reported adverse effects are by no means life threatening but can still have a negative impact on the anabolic steroid user. Some of the most common of these effects can be termed cosmetic.

Physical Harm

Self-reported acne is a common finding in questionnaire-based studies. Some case reports documented severe forms of acne such as acne conglobata or acne fulminans.
Male pattern baldness has been shown to be androgen-dependent (Randall, 2004). It is conceivable that in those who are genetically predisposed to this form of scalp hair loss, the use of certain types of steroids could accelerate the progression of hair loss. Conversely, many steroid users report increased growth of body hair when using steroids. From the limited data available growth of facial hair may be particularly pronounced in female users.

Gynaecomastia is the growth of the glandular breast tissue in males, caused by an imbalance in the ratio of oestrogen to testosterone. This imbalance is a direct result of an excess of testosterone resulting in aromatisation (conversion of excess testosterone into an oestrogen like compound. This in turn can cause the growth of breast tissue and female fat distribution. Those anabolic steroids with a high androgenic component are more likely to result in this adverse effect. Many of the drugs commonly used in conjunction with anabolic steroids such as growth hormone, human chorionic gonadotrophin, spironolactone) have also been clinically associated with gynaecomastia.

Anabolic steroid use can suppress endogenous testosterone leading to shrinkage of the testes. It can take a prolonged period for testicular production and fertility to recover. Many anabolic steroid users report increased libido while using steroids, conversely on cessation of use, libido is often decreased below original levels. Erectile dysfunction has also been reported both during use and following cessation of use. There have been a small number of case reports of renal cancers in individuals who reported use of anabolic steroids. But, as in the case of many of the more serious side effects of anabolic steroids, a causal link has not been fully ascertained.

The use of anabolic steroids, in particular oral C17 alpha alkylated steroids (such as methandienone and oxymetholone), has been associated with disease and dysfunction of the liver, with cases of jaundice being relatively common. The extent of impact on liver function is inconclusive with studies reporting diverse results and conclusions. However, there have been a small number of case reports of liver tumours in anabolic steroid users.

The use of anabolic steroids has been associated with a range of both acute and chronic cardiovascular pathologies. Reported adverse effects include hypertension, altered lipid metabolism, altered haemostatic system, cardiac arrhythmias, myocardial infarction, stroke, thrombosis, sudden cardiac death and cardiac hypertrophy However, much of the data related to these cases is equivocal.

The majority of anabolic steroids are injected. Individuals who inject are potentially at risk of a number of potential issues that include:
1. Damage to the injection site as a result of poor injecting technique.
2. Bacterial and fungal infections as a result of poor injecting technique, contaminated drug products, and sharing vials and/or reusing injecting equipment.
3. Blood-borne viruses (BBV) such as HIV, hepatitis B and hepatitis C as a result of sharing used injecting equipment (direct sharing) or reusing injecting equipment and, subsequently, sharing vials with others (indirect sharing).
For free sterile injecting equipment and advice please visit one of your local needle exchanges. Directories to your nearest confidential needle exchange can be found at: InEngland: www.talktofrank.com or call 0300 123 6600InScotland: www.scottishdrugservices.com or call 0141 221 1175InWales: www.dan247.org.uk or call 0808 808 2234

Psychological Harm

There is insufficient evidence to prove a causal link between anabolic steroid use and addiction or dependence. However, there is evidence to support the positive psychological and physical effects experienced by many users, leading to reinforce the continuing use of steroids. Furthermore, the escalating dosage often reported by users together with a preoccupation with the drugs themselves and the associated lifestyle indicates some commonality with drug dependency syndromes. While this is not exhibited by all users of anabolic steroids, there appears to be a number of users for whom this is the case.

It is not uncommon for anabolic steroid users to self report a lowering of mood or depression on cessation of anabolic steroid use. This is attributed to a fall in circulating testosterone due to a shutdown of a natural endogenous testosterone in response to the self administration of anabolic steroids. This fall in testosterone (described as a “crash” by some) is, to some degree, inevitable and for some is a catalyst to return to using anabolic steroids.

Evidence related to link between aggression or violence and the use of anabolic steroids remains inconclusive and often contradictory. A systematic review of this subject concluded that there are currently insufficient data to prove a direct causal link between anabolic steroid use and aggressive and violent behaviour. Studies are often confounded by issues such as expectancy of drug effects, predisposition to specific behaviours and lifestyle and circumstances. However, it is not uncommon for users to self-report increased ‘aggression’ when using anabolic steroids which for some, there is a belief that this effect can be used instrumentally, for the positive purpose of training or performance.